US Cohort Highlight – Christine Ngaruiya

Briefly describe the highlights of your work experience: What are you passionate about? Beatrice was small in stature, but her size belied the energy that radiated from within, an energy that eclipsed a history mired by marked challenges that had landed her in the heart of the Midwest as a refugee from Burundi. I first met Beatrice while volunteering at a French service, which my church provided specifically for this community. I volunteered to attend and help out given my competency in the language. Beatrice always had a radiant smile, and willingly offered embraces, with her young husband and their newborn in tow. One day at the service, she appeared solemn as their infant wailed loudly on end, inconsolable, congested and coughing. It struck me. Where would they go for care? Did they know how to get there? If so, how would they afford it? Although only a junior medical student at the time, I knew that something could be done. That something had to be done. The rest was history, and a global health career took root. I applied for, and secured a foundation grant to develop a program based on Community-Based Participatory Research (CBPR) principles called Bridge to Care. A health education and linkage to care program that has served more than 5000 refugees across Nebraska since inception in 2010, Bridge to Care has been incorporated into the service-learning track at the University of Nebraska Medical Center and has won multiple accolades, including the Dean of the School Public Health award. Focusing on refugee populations in Nebraska, the lead resettlement state per capita in the US, was important to me. I continued in this space, serving on the board of the largest resettlement agency in Connecticut (IRIS) over the past four years. All the same, I continued to have the desire to return to the place of my upbringing in Kenya, to affect care there. Since my global health fellowship in the Department of Emergency Medicine at Yale University in 2013, with a concomitant Masters of Science in Tropical Medicine and International Health from the London School of Hygiene and Tropical Medicine, I have dedicated my focus to East Africa, and Kenya in particular.  Over the past seven years, I have forged relationships with a variety of partners in East Africa to address Non-Communicable Diseases (NCDs). Learning about this phenomenon of systematic differences in outcomes among underserved populations for the first time as a sociology major in University, the topic of NCDs struck me as one of the most unfortunate areas of health disparities. Unfortunate, because the opportunities to act on reducing these disparities seem so apparent, yet remain out of reach due to lack of access. At the start of my fellowship, I was compelled to focus my work on affecting NCD-related disparities in Africa, and my home country. I contributed as a senior collaborator on the first ever national study on NCDs, a WHO validated survey, which was a collaborative effort between the Kenya Ministry of Health and a variety of local NCD stakeholders. Because of our work, Kenya became the first of more than 180 WHO member states to complete the study and publish in a high impact journal (10 sub-analysis studies/ papers published in BMC public health). With such key knowledge, primary data, it is possible to design targeted interventions and allocate resources accordingly. I have contributed to a variety of other projects across Africa, including as a co-founding member of the Yale Network for Global Non-Communicable Diseases (NGN), a hub for global NCDs at Yale, and as a regular contributor to the African Federation for Emergency Medicine. As a dedicated Emergency Medicine physician, who like many others was drawn to the specialty given the opportunity to serve those at the margins of care, I was cognizant that disparities in NCDs in the Emergency Department (ED) were likely to be disproportionate in EDs in East Africa too. In 2018, I led an epidemiological study on NCDs and mental health in a large sample size of patients (~1,000) in the busiest hospital in East Africa, Kenyatta National Hospital, located in Nairobi. This study is the first ever dedicated to NCDs and NCD risk factors in an Emergency Department in Africa of this size, and was key in demonstrating the importance of addressing NCDs in ED populations. The outcomes on NCDs among patients accessing care in the Emergency Department are systematically worse when compared to the general population – as compared to the studies that I had just participated in with the Ministry of Health a few years prior. This was a novel addition in advancing the science on the importance of emergency care in Africa. At this time, I am working to develop interventions targeting lead NCDs and NCD risk factors in ED populations, such as tobacco use, alcohol use and cardiovascular disease. I am particularly interested in leveraging mobile health (mHealth) technology, which is the use of mobile phones to improve health and healthcare outcomes. In support for this, in another recent study, we found that mHealth was just as accessible for marginalized populations such as women, contrary to hypotheses of lack of autonomy in places like Kenya. We found instead that in this Kenyan population, women were twice as likely to have engaged with mHealth as compared to men, and titled the paper accordingly: “Target women: Equity in access to mHealth technology in a non-communicable disease care intervention in Kenya.” The paper was published in PLoS One in 2019. My passion will continue to be in advancing research and care for the underserved with a particular focus on international populations where disparities are exceedingly worse. Through this focus, as a first-generation Kenyan, and a racially under-represented woman in medicine, I remain mindful about the pipeline, mentorship and research capacity-building particularly for women. Over the years, I have mentored and taught hundreds of trainees, both in the U.S. and Africa, and I am keen to be developing a research capacity-building initiative with a focus on women in Africa as part of my WomenLift Leadership Journey. In summary, it is challenging to describe what I have been involved in for the past 15 years as “work.” I categorically would be doing the exact same thing that I am doing right now, whether or not I was getting paid. In particular, that has involved designing, developing, assessing, and implementing novel interventions targeting individuals from underserved populations with a particular focus on health disparities and access to care. My “work” will be done when equity in health is no longer a measure that we have to analyze in our fields to understand where the greatest need exists, because there will be an even playing field. This is what work looks like to me.